___________________________________
Graduation Year
Date
Date
Date
____________________________
____________________________
_________________________________________________ ____________________________
Counselor/Principal Endorsement
Name of High School
Parent/Guardian Signature
Student Signature
SSN __ __ __ -__ __ -__ __
__ __
If yes, did you pay?
Yes
MM / DD / YYYY
MIDDLE NAME FIRST NAME LAST NAME
Request to Waive or Defer Admission Application Fee
Name_____________________________________________________________________________________
Birthdate ____/_____/_______
Term Applying For:
Have you completed an application for that term?
No
Yes No
Request for fee waiver or deferment is based on (Check where applicable):
ACT Test Fee W
aiver (will be charged to student account)
Free or Reduced Lunch (will be charged to s
tudent account)
Student participates in f
ederally funded TRIO programs including Upward Bound,
Talent Search, Student Support Services, etc. (will be waived)
This form is only available to current high school students who meet the above criteria or TRIO participants
involved with either high school or college TRIO programs. Only students participating in
federally-funded TRIO programs will have their application fee waived. Students who select the ACT Test Fee
Waiver or Free or Reduced Lunch option will have their fee deferred to student account and are responsible for
prompt payment of application fee.
I certify that all statements made on this application are true. I hereby consent to release of my financial aid and/
or other educational records to the appropriate officials at the University of Central Oklahoma as may be neces-
sary to confirm my financial need and inability to pay this fee.
_______________________________________________
_______________________________________________
_______________________________________________
Student must complete application up until the payment screen before submitting this form.